Recently, the news of a 29-year-old woman in Ningbo city who developed fatty liver while trying to lose weight on a vegetarian diet has become a hot topic. The woman, who is 160 centimeters tall and weighs 116 catties, was found to have mild fatty liver during a check-up. She attempted to lose weight by adopting a vegetarian diet, only consuming boiled vegetables and steamed miscellaneous grains. After successfully losing 10 catties in six months, her mild fatty liver unexpectedly progressed to moderate fatty liver. She became thinner, but her liver became “fatty.” Why did this happen? Associate Chief Physician Zhang Ningping from the Gastroenterology Department of Zhongshan Hospital affiliated to Fudan University explained, “Fatty liver is not exclusive to obese individuals. ‘Starve’-induced fatty liver is not an isolated case.”
Why does weight loss lead to fatty liver?
In a normal person, the liver contains small amounts of fat such as triglycerides, phospholipids, glycolipids, and cholesterol, generally accounting for 3% to 5% of the liver’s weight. When the fat content exceeds 5%, it is termed fatty liver. Typically, fat content exceeding 5% to 10% of the liver’s weight is considered mild fatty liver, 10% to 25% is moderate fatty liver, and over 25% is severe fatty liver. With dietary changes and lifestyle modifications, the incidence of fatty liver in China has been rising. Currently, the prevalence of fatty liver among Chinese adults is estimated to be between 20% and 30%, with an increasing trend as age advances.
“This upward trend reflects the common unhealthy lifestyle in modern society, such as high-calorie diets, lack of exercise, etc. While fatty liver is indeed more common in the obese population, it does not mean that lean individuals are immune. From outpatient cases, many fatty liver patients are not obese. Common reasons for lean individuals developing fatty liver include rapid weight loss, malnutrition, long-term vegetarianism, excessive alcohol consumption,” Zhang Ningping told reporters. When the body is in a prolonged state of starvation, it cannot obtain essential glucose and enzymatic substances required for lipid oxidation. To compensate for the lack of glucose, the body mobilizes stored fats and proteins from other areas and converts them into energy through the liver, the “chemical factory.” Consequently, a large amount of raw material (fatty acids) accumulates in the liver, leading to fatty liver.
Furthermore, weight loss resulting in insufficient nutrient intake affects protein and phospholipid synthesis in the body, causing a deficiency in lipoproteins. Excessive triglycerides exceeding the lipoprotein transport capacity leads to fat retention in the liver, also contributing to fatty liver.
Positive lifestyle adjustments can “reverse” fatty liver
Often, fatty liver does not affect regular life, but it is a progressive disease that can develop into non-alcoholic steatohepatitis (NASH), liver fibrosis, or even cirrhosis, potentially leading to liver cancer. However, having fatty liver does not need to cause excessive anxiety. In general, fatty liver is a reversible disease, and early diagnosis and timely treatment can lead to recovery.
35-year-old Ms. Li enjoys drinking milk tea, almost daily one cup, sometimes more. With a busy work schedule and lack of exercise, her weight gradually increased, and she was diagnosed with mild fatty liver. At that time, she did not pay much attention, thinking that drinking milk tea was trivial and fatty liver would not pose significant problems. About a year later, Ms. Li felt frequently tired, lack of energy, and even had a poor appetite at times. When examined again, she was diagnosed with non-alcoholic steatohepatitis (NASH), and her liver function showed abnormalities. The doctor informed her that if left untreated, it could progress to liver fibrosis or even cirrhosis.
Realizing the severity of the issue, Ms. Li decided to make changes. She quit her daily milk tea habit, opting for water or unsweetened tea. Simultaneously, she started controlling her diet, reducing high-calorie foods, engaging in brisk walking and yoga daily, and exercising more than five times a week. After six months of effort, Ms. Li lost 8 kilograms, and her liver function indicators returned to normal. During a follow-up hospital visit, the doctor informed her that her NASH had significantly improved, and her liver had essentially regained health.
“Even if fatty liver progresses to non-alcoholic steatohepatitis, with proactive lifestyle interventions, such as giving up sugary drinks and increasing exercise, fatty liver can be reversed. This indicates that certain daily habits may have a significant impact on health and must be taken seriously,” Zhang Ningping said.
Image of Dr. Zhang Ningping Source/Provided by interviewee
Avoid rapid weight loss; weight reduction not exceeding 10% in six months is appropriate
Although fatty liver is common, there are numerous misconceptions regarding it. For instance, the biggest misconception is that being “slim” protects against fatty liver. Typically, “slim” refers to individuals with a normal Body Mass Index (BMI) as defined by the World Health Organization. Yet, whether these individuals are “truly slim” or “viscerally slim” depends on their waist circumference. If limited fat is distributed around the abdomen, they are still at high risk of fatty liver.
The second misconception is that “weight loss can reverse fatty liver.” Zhang Ningping stated that weight loss is an effective treatment for fatty liver but should not be excessive. Following scientifically sound weight loss methods is essential, avoiding excessive or rapid weight loss. Effective weight loss involves reducing 5% to 10% of total body weight within six months.
Weight loss is not the goal; the goal is better health. How can one scientifically and effectively lose weight while avoiding fatty liver? Zhang Ningping suggested starting with a balanced diet, scientifically planning three meals a day, controlling the total caloric intake, and adjusting poor dietary structures. Adequate intake of quality fats (such as unsaturated fatty acids) is recommended, as these fats help stabilize blood sugar, preventing rapid insulin spikes that can lead to increased fat accumulation in the liver. Ensure protein intake, consume more high-fiber foods to improve gut health, minimize consumption of refined carbohydrates like white rice and flour, and sugary foods; avoid or limit alcohol consumption; reduce consumption of fried and highly cooked foods; and minimize intake of trans-fatty acids.
Additionally, incorporate appropriate exercise. Aerobic exercise can boost metabolism, promote energy consumption, prevent surplus energy from converting into accumulated fats, and effectively break down accumulated fats in the body, making it the most efficient and healthy weight loss method. However, exercise should be gradual and proportionate to avoid health damage from improper or excessive physical activity.
Zuo Yan, Xinmin Evening News reporter
